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1、侵袭性血管粘液瘤的临床及病理分析作者:李容,李宗恒单位:绵阳市第三人民医院妇产科,四川绵阳621000;泸州医学院妇产科,四川泸州646000【摘要】目的探讨侵袭性血管粘液瘤(aggressiveangiomyxoma,AAM)的临床病理特征及治疗方法。方法回顾性分析2例侵袭性血管粘液瘤的临床病理学资料。结果2例均采取手术治疗,1例患者给予肿瘤包块切除后复发,复发者及另一例均采取局部广泛切除,至今未见复发。术中见:肿瘤无包膜,剖面均一灰白色、胶质样,有粘液性间质分隔。病检示:瘤细胞呈梭形或星形疏
2、松排列于粘液间质背景屮,核无有丝分裂活性,其间有厚壁血管。免疫组化显示:desmin,vimentin,ER,PR(+),SMA、S-100(-)o结论AAM是一-种罕见的、局部浸润性间质肿瘤。侵袭性、复发性是其重要特征,需提高首次诊断的正确性,首次治疗以局部广泛切除为宜,月.需长期随访监测。【关键词】侵袭性血管粘液瘤;手术治疗;病理分析ClinicalandPathologicalAnalysisofAggressiveAngiomyxomaLiRong,LiZonghen,theSecond
3、People'sHospitalofMianyangCity,SichuanProvince621000ABSTRACT0bjectiveTodiscusstheclinicalpathologicalfeaturesofaggressiveangiomyxoma(AAM)andthetreatment・MethodsAretrospectiveanalysiswasmadetotheclinicalpathologicaldataof2caseswithAAM.ResultsThefirstc
4、asesufferedfromrecurrenceafterexcisionofthetumor,andthenlocalwideexcisionsweremadetothefirstandsecondcases,withnorecurrencetillnow・Intheoperation,itwasseenthatthetumorhadnopeplos,thesectionofthetumorwashomogeneousgrayandcolloidal,withdissectionofmuci
5、laginousstroma;Thepathologicalstudyrevealedthatthetumorcellswerespindle-shapedorstar-shaped,looselyringinginthemucilaginousstromawiththick-walledvessels,thecellnucleushadnomitogenactivation;immunohistochemicalstudyshowedpositivedesmin,vimentin,ERandP
6、R,andnegativeSMAandS~100.ConclusionAAMisakindoflocalinfiltratingmesenchymalneoplasm,raretobefound,withthefeaturesofinfiltrationandrecurrence:itisimportanttoraisethecorrectpreliminarydiagnosisrate:thepreliminarytreatmentshouldbelocalwideexcision,andlo
7、ng-termfoilow-upshouldbemade.KEYWORDSaggressiveangiomyxoma(AAM)surgicaltreatmentpathologicalanalysis侵袭性血管粘液瘤(aggressiveangiomyxoma,AAM)是一种罕见的、局部浸润性间质肿瘤,1983年首次被Steeper和Rosai发现[1]。它生长缓慢、低度恶性、通常侵袭育龄期妇女盆腔和会阴,但偶有报道发生于男性,男女之比约1:6[2],局部复发率高,首次局部广泛切除和术后长期随访
8、是必要的。我院收治外阴、阴道AAM2例,均行手术切除,至今未见复发,我们结合文献总结AAM的病理特征,探讨其治疗方法。1资料与方法1.1病例简介例1,29岁妇女,孕3产1,发现右侧外阴包块半年于2000年3月收入院。查体:全身浅表淋巴结未见肿大,妇科检查:右侧大阴唇近阴唇后联合处皮肤局限性降起,表面色泽正常,无静脉曲张,无皮温升高,肿块约5cm×4cm×3cm,边界尚清,质地中等,无压痛,局部有囊样感,欠活动,左侧正常,阴道通畅、粘膜色泽正常。入院诊断:“右侧